Carbohydrate counting combined with DASH diet provides benefits in gestational diabetes
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Carbohydrate counting combined with the Dietary Approaches to Stop Hypertension eating plan may help women with gestational diabetes to lower fasting blood glucose, according to a study published in Clinical Nutrition.
In a randomized controlled parallel-arm trial of pregnant women with gestational diabetes from Jordan, participants randomly assigned to carbohydrate counting with a Dietary Approaches to Stop Hypertension (DASH) eating pattern had significantly lower fasting blood glucose (FBG), insulin and 1-hour postprandial glucose levels than those in a control group.
“These findings suggest that carbohydrate counting combined with DASH dietary intervention is more effective for improving glycemic control in gestational diabetes women,” Reema Tayyem, PhD, professor of clinical nutrition in the College of Health Sciences at Qatar University, and colleagues wrote. “The explanation for these findings is that participants of carbohydrate counting group and carbohydrate counting combined with DASH group distributed their carbohydrate intake throughout the day in three small to moderate meals and three to four snacks.”
Researchers recruited 75 pregnant women with gestational diabetes prescribed metformin between the 24th and 30th week of gestation to participate in the trial. All participants were attending antenatal clinics at Al-Bashir Hospital and Jordan University Hospital. Participants were randomly assigned to carbohydrate counting, carbohydrate counting combined with a DASH diet or a control diet with no carbohydrate counting. The intervention lasted 8 to 12 weeks from enrollment until delivery. The control diet contained about 45% to 55% carbohydrates, 15% to 20% protein and 25% to 30% fat. Those in the carbohydrate counting groups received education on food portion size, package labels, managing hyperglycemia and hypoglycemia and more, with calorie, protein, carbohydrate and fat content similar to the control diet. Those in the DASH diet group ate more fruits, vegetables, cereals, low-fat dairy and nuts and less lean meat. FBG, insulin, HbA1c and fructosamine levels were measured at baseline and the end of the study. Participants were asked to perform blood glucose monitoring at least four times daily. Newborn and maternal outcomes were obtained from medical records.
Seventy women completed the trial, including 24 in the control group and 23 each in the carbohydrate counting and the carbohydrate counting combined with DASH diet groups. At the end of the intervention, all three groups had decreases in FBG compared with baseline, with the carbohydrate counting group having a significantly lower FBG level of 78.5 mg/dL compared with the DASH group (80.9 mg/dL) and the control group (86.7 mg/dL; P = .021). The DASH group had a lower insulin level of 48.7 pmol/L compared with the carbohydrate counting group (79.3 pmol/L) and the control group (86.6 pmol/L; P = .026).
“The carbohydrate counting diet and the carbohydrate combined with DASH diet could significantly reduce the number of women who are required to initiate insulin therapy,” the researchers wrote. “One explanation for this finding is that the carbohydrate counting diet and the carbohydrate combined with DASH diet were effective in achieving glycemic control.”
In an analysis of daily home-monitored blood glucose, FBG was lower in the DASH group and the carbohydrate counting group vs. controls (81.8 mg/dL vs. 81.3 mg/dL vs. 88.4 mg/dL; P = .002). The DASH group had lower 1-hour plasma glucose than both the carbohydrate counting and control groups, specifically after breakfast and dinner (P < .001).
There were no differences in any maternal or neonatal outcomes between the three diet groups except for insulin therapy. Ten participants in the control group needed insulin compared with three each in the carbohydrate counting and DASH groups (P = .026).
“The carbohydrate counting combined with DASH diet appears to be a safe alternative to the conventional pregnancy diet for women with gestational diabetes and enlarges the range of dietary strategies that can be recommended to gestational diabetes pregnant women,” the researchers wrote.
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